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An Analysis of Childhood Asthma and Environmental Exposures in Utah
Michelle Gillette, M.P.H.Office of Epidemiology
Utah Department of Health
Asthma in the United States
• Increasing prevalence in all age, sex, and racial groups (NHLBI Data Fact Sheet, 1999)
Trends in Asthma Prevalence by Age
0
10
20
30
40
50
60
70
80
1980 1981-83 1984-86 1987-89 1990-92 1993-94
Year
Rat
e pe
r 1,
000
pers
ons
0-45-1415-3435-6465+
National Heart, Lung and Blood Institute, 1999
Age
Asthma in Utah
• Hospitalization due to asthma– 12.3 asthma cases per 10,000
children ages 0-14 for 1992-1995 (LeFevre, 1997)
• Childhood asthma hospitalization rates at the zip code level – Analysis conducted in four
Urban counties
Previous Study Data:
84 0 4 4 84 1 0 4
84 1 1 6 84 1 0 3
84 1 1 984 1 2 0
84 1 1 8
84 0 8 4
84 0 8 8
84 0 0 684 0 9 5
84 0 6 584 0 2 0
84 0 9 2
84 1 1 784 1 0 6 84 1 0 9
84 1 2 4
84 1 2 184 0 4 7
84
07
0
84
09
4
84
12
3
84
10
78
41
15
84
101
841
11
84 0 9 3
84 1 0 5 84 1 0 8
11 211 310 2
84 1 1 7
84 0 5 4 84 0 1 0
84 0 8 7
84 0 1 4
84 0 2 5
84 0 3 7
84 0 4 0
84 0 4 1
84 0 7 5
84 0 4 384 0 0 3
D A V IS C O U N T Y
M O R G A NC O U N T Y
T h eG r e a tS a lt L a k e
S A L TL A K EC O U N T Y
L a k e s
A s t h m a H o s p i t a l R a t e s ( 1 9 9 2 - 1 9 9 5 )
S ig n i f ic a n t ly L o w e rN o t S ig n i f ic a n t l y D i f f e r e n tS ig n i f ic a n t ly H ig h e r
N o C a s e s R e p o rt e d
F r e e w a y s
C o u n t y B o u n d a r ie sSignificantly Lower
Not Significantly DifferentSignificantly HigherFreeways
Asthma Incidence Rates by Zip Code (1992-1995) Ages 0-14
Salt Lake County
The GreatSaltLake
N
E
S
W
Asthma in Utah
Increased Rate Of Childhood
Asthma
Many Industrial
Emission Sites
Relationship?
In Western Salt Lake County:
Study Objectives
• Analyze the spatial and temporal variation of childhood asthma within four urban Utah counties
• Determine if there is a relationship between childhood asthma development and proximity to industrial emission sources
Study Population
• Study Location– Four urban
Utah counties – Approx. 77%
Utah’s population
• Asthma Cases–ICD-9 code 493–1990-1999–Ages 0-14
Salt Lake City
Salt Lake County
Utah County
Davis County
Weber County
Salt Lake City
GreatSalt Lake
UtahLake
Counties Major Roads Major Lakes
Childhood Asthma Study Area
Data Collection: Asthma Cases
Hospital Discharge Data:•11,522 Cases•Name•Birth Date•Sex•Date of Admit/Discharge•Address at time of hospitalization
Data Collection: Asthma Cases
Birth Certificate Data:•8,932 Unique individuals•Race•Tobacco Use (Mother)•Alcohol Use (Mother)•Congenital Anomalies•Birth Address
Data Collection: Emission Sites
• NPL• CERCLIS• RCRA• TRI• Point Source Emissions
Sources of Hazardous Emissions:
UtahLake
Great Salt
Lake
Industrial Emission Sites (1990-1999)
NPLTRI
CERCLISPSE
RCRA
X
Data Collection: Confounders
• Socioeconomic Data– 1990 and 2000 Census Data
• Access to Healthcare– Proximity to hospital
• Climatological Data– Wind speed & direction, temp,
humidity
Data Analysis: Statistical Tests
• Cluster Identification through Spatial and Temporal Analysis– Are cases close together in space and time?
• Statistical Tests Used – Knox Test– Moran’s I– Gedis-Ord G– Geary’s C
Data Analysis: Statistical Tests cont.
• Relationship between emission sources and asthma cases– Lawson test
• Point-specific analysis– Rule out potential confounding
factors (i.e. socioeconomic & climatological data)
Status of Study
• At this point:– 11,522 cases mapped based on
address at time of hospitalization
– 8,032 cases mapped based on birth address
– 6,094 industrial emission sites identified and mapped
Conclusions
• Previous study indicates increased incidence of asthma in certain areas
• Ongoing analysis to identify clusters and evaluate relationship to emission sources
• Final Results available Fall 2002
Questions?
• Contact Information:Michelle Gillette, M.P.H.Office of EpidemiologyUtah Department of Health(801) [email protected]
Funding for this study provided by:
The Agency for Toxic Substances and Disease Registry Cooperative Agreement #U50/ATU887580-03
Additional assistance provided by Dr. R. Wayne Ball, Greg Williams, Amy Coombs, Samuel LeFevre, and the University of Utah Digit Lab
References
National Heart, Lung, and Blood Institute, National Institutes of Health, Centers for Disease Control and Prevention. (1999). NHLBI Data Fact Sheet: Asthma Statistics, January 1999. http://www.nhlbi.nih.gov/health/prof/lung/asthma/asthstat.htm
LeFevre, S., and Ball, R.W. (1997). Health Assessment: Asthma Hospitalization Rates Among Children in Utah.